Recovering from MPFL Reconstruction
How the first week following my MPFL Reconstruction Surgery went.
T+Plus 1 Day: Recovery Road
Going to sleep that first night after surgery was relieving; after spending so many nights the two weeks up to that point wide awake reading and re-reading horror stories about people’s painful MPFL surgeries, mine was finally done, and I wasn’t dying of pain; just exhausted and generally sore. Somehow I’d managed to stay up late that first night, despite the exhaustion; part of me was wired from being excited to be recovering, and part of me was just delaying expending any effort in moving anywhere — I hadn’t attempted a staircase yet.
Going up the 14 steps to my bed was just slow and tiresome, but not difficult. I’d already managed doing it in May on crutches, and it was no different now, except that doing anything and everything hemorrhaged precious energy. Arriving to my bed, I quickly decided to remove my fuzzy fleece blanket and just lie on top of the covers, and just sleep under the loose fuzzy fleece. This was such a good call; my wrapped up and braced left leg was free underneath, unconstricted, and I could easily get up and out of the blanket in an instant. I propped my leg up on a spare memory foam pillow. The blanket was cozy and surprisingly warm enough used alone even while I like sleeping in a cold room — it actually got too hot at times over the coming weeks. On my nightstand was my phone (charging, with alarms set every 4hrs for pain pills), a glass of water which eventually was replaced with a Camelbak bottle (fits great in gym short pockets for transport on crutches), Percocet, Aspirin, Excedrine, Midrin, Zofran just in case, and some leftover Dilaudid (also just in case; I wasn’t sure what kind of pain I’d be in when the nerve block wore off). Also present were tissues and my crutches. As with all doors between this point and recovery, the door was left unlocked just in case of accident or emergency.
I slept great. I plopped down and fell asleep almost instantly, and didn’t wake up until my first Percocet alarm. Like the evening of the surgery, pain was very managed; I was sore and in pain, don’t get me wrong, but it wasn’t sharp, it wasn’t throbbing, it was just soreness that got more and more intense as the Percocet wore off. I described it as feeling like someone had smashed a cinderblock on my knee — not the pain of actually having a cinderblock smashed, but the pain you’d have afterwards. The pain still wasn’t bone pain; it was just the kind you get with bruising and muscle trauma and cuts. In fact, the pain that was hurting really badly (and would eventually keep waking me up over the next few days) wasn’t from the knee at all — it was a stabbing pain on my achillies tendon on my operated leg. I chocked it up to the surgery team placing a compression device on the ankle to assist movements during the surgery, but I’d eventually learn this was not the case at all, and that I had a large, untreated gash on the back of my ankle — I think this was a medical mistake. My theory is that my leg was dropped during surgery and hit something that cut it, either without anyone noticing, or it was willfully ignored by staff to avoid consequences. The point is, the pain from this gash, which could be easily gotten by just falling off a bike, was more painful than the surgical site itself. Crazy how that works sometimes.
The day after surgery I woke up really, really late — like 5PM late. I knew it was more important to sleep and give the body a chance to recover than to maintain a “normal” sleep schedule, so I felt no guilt! This general pattern would continue for the first two weeks.
I was hungry, but not starving, and with a change of clothes and adding some deodorant, I began the slow process of going down stairs. My advice is to take everything slow, and don’t do anything you’re unsure about. It took me a few steps to relearn my process of going down steps on crutches, non-weight bearing on one leg. I found it easiest to hold onto the railing, advance both crutches down to the next step, then advance your non-weight bearing foot down the step, brace your weight on the crutches, and while still holding the handrail then advance your weight-bearing foot down. Rinse and repeat. It’s just 14 steps, but going down got me out of breath and working up a sweat, and it’s not like I’m out of shape! Up is much faster and easier!
Getting downstairs, I took my place in the chair with an ottoman to prop my leg up on and watch Netflix and poke around on the computer. I quickly learned that I had absolutely zero concentration within me to do anything productive such as begin writing this blog, or edit personal pictures (I’m a professional photographer, if you didn’t read my bio). I’d arranged for some soup and other mild foods to be available, but I was up for anything — I have a very strong stomach, so your milage may vary; people who suffer from nausea may still have a weak stomach even 24hrs later, so plan conservatively to be safe.
Since I was wrapped up, I still hadn’t seen my knee (dressing is allowed to be removed on day 3), but it was pretty sore just like when I’d gone to bed, so I began using the cold therapy unit. There are different brands available, but they all work on the same principle — ice water is circulated from a cooler through a slim pad fitted to your joint, via an insulated hose. There is also a cold therapy unit by Gameready which provides compression as well, and inflates like a large blood pressure cuff.
In my case, instead of using ice I had a supply of ice packs to rotate, which was much easier than dealing with dangerous ice; screw ice — it’s what got me into this whole mess to begin with!
And that was my day; talk with more friends about how the surgery went, watch movies, and play the Stranger Things game on my phone. I was closely monitoring, but even 24hrs later there was no sign of my nerve block wearing off. I had been told that it would be worn off within 24–36hrs, but still nothing yet; I had a nice numb spot about 6" circle centering on my patellar tendon.
Before bed I did something I had been dreading, and also (as everyone has experience and can understand) was looking forward to. I “used the bathroom” if you know what I mean. I’m including this becuase it’s a tip I think everyone can benefit from. When you’re forced to keep your leg straight, that makes sitting without something to support your straight leg just suck. Well, in May when I went through the same thing, here is the system I developed:
It’s quite beautiful actually. I stole the spare walker from my mom (don’t worry, this is her spare she doesn’t use!), and had it in my shower, set up and ready for when I am allowed to take showers again. So the walker serves a dual purpose; shower support, and toilet-leg support while bending is disallowed.
Also notice that I am wearing gym shorts and a T shirt — you want to only wear comfortable, loose and / or stretchy clothing. Furthermore, I found it easiest to only wear a shoe on my healthy foot, and just wear a grippy hospital sock on my operated left. I stacked socks — the hospital sock is covering a normal sock. It’s not stylish, but it serves the purpose of helping keep that foot off the ground while moving. Non-weight bearing means you are allowed to gently rest your foot on the ground (I call it “toe weight”) but not actually stand on it — you are allowed to allowed to use your leg for balance-keeping and navigation, but nothing more. I was told by the post-op nurse that in the event of losing my balance to use my operated leg and catch myself rather than fall.
I’ve seen lots of documentation of other (probably most) doctors maintaining a much more aggressive rehab protocol after MPFL reconstruction surgery — lots say patients are allowed full-weight bearing immediately after surgery, locked out straight in a brace, plus encourage bending the knee soon after surgery. I know I was full-weight bearing in my operated leg straight out of surgery (with the added benefit that I didn’t lose any muscle function, which is apparently unusal for this surgery). That being said, follow your doctor’s orders. I rather like that my orthopedist seems to treat recovery very conservatively because it (hopefully) means there is some headroom if mistakes are made. I followed my three-week sentence in leg-prison to a T until three days before my 21-day timer was up; that’s when I cheated and began weaning into partial-weight bearing three days early.
T+Plus 3 Days: The Game
I overslept again, but that’s of no concern. I awoke refreshed and with energy, because today is the first game of the NLDS with the Washington Nationals playing the Chicago Cubs — some friends were coming by to watch Game 1 with me and see how I’m doing after the surgery.
This all meant that I had the energy (and need) for a sponge bath for the first time since surgery; there was a slight learning curve since I’ve only had to do that a few times in May, but I managed it slowly, as best I could. With a towel on the counter, I stood naked except for my brace, balancing on one foot bracing myself on the counter, and used a wet washcloth to give all reachable and exposed skin a rinse, then a soapy pass, then another rinse, with most priority given to the “pits and the bits.” The process is slow, tiring, and imperfect, but it gets the job done until I was allowed to shower again once the wounds healed enough. My protocol said I could shower beginning day 4 so long as I wrap my leg in saran wrap to cover the dressing (which was the entire leg at this point) and subsequent wound — I knew it would just be eaiser to tough it out for the 12 days until my post-op follow-up to get my closures removed, and just stick with sponge baths until then, so that’s what I ended up doing. After finishing up, I wrapped the towel around my waist and carefully took the two crutch steps off the tile bathroom floor and onto the safe grip of carpet — after all, I was sponge-bathing on one foot in the exact spot where I fell and tore my MPFL in the first place; a haunting feeling to say the least. With my operated leg stretched on my bed I got dressed in fresh clothes, being sure to wear my Nationals T-shirt and cap to mark the occasion. I’d wash my hair later in the kitchen sink downstairs which is much larger and has a detachable spray faucet. This is how I got ready most every day, except the occasional bad days when I woke up with no energy.
My friends Jake and Imran arrived, and we got our pizza order placed so it would arrive before the game started while I relaxed with the ice therapy machine and told them about how the surgery went so much easier than I’d expected. Before they’d arrived, I’d gotten a hold of my orthopedist’s PA to make sure I wasn’t seeing a complication with my knee because the nerve block hadn’t worn off yet — I still had no feeling on the lower portion of my knee and upper part of my shin! He explained that this was totally normal, and wasn’t caused by the nerve block, but rather a nerve that in unavoidably severed when harvesting the gracilis tendon. This sensation loss is normal, expected, totally safe, and will gradually shrink away slowly in 6–12 month. It also explained why I was now able to touch the side of my knee at the femoral incision site vertically and feel it very intensely moving horizontally on the upper part of my shin on the edge of where I lost sensation. The PA also explained that the nerve block had long worn off by this point, and I just hadn’t noticed it — I felt no different with or without the nerve block! That being said, it’s not a reason to skip having one — if I hadn’t had the nerve block, I can assure you that I’d be writing you a very different story in terms of pain. The nerve block will block out the initial pain shock to the system, letting you skip that and jump right into the recovery pain baseline — that is (to the patient) the nerve block’s purpose, and is so incredibly worth it! Or Werth it — the Nats game was about to start!
Having some friends come by provided a boost of energy I’d been lacking since coming home from surgery. Even though the blood-rush of standing and crutching to the kitchen and back to choose my pizza was painful and draining, I was energized and moving much quicker. I really just wanted to sit though, and that’s what I did except to pick out another slice selection and to hit the bathroom between innings. I ran the ice machine off and on through the whole game, and it really helped keep the swelling pain in check, with the Percocet doing the rest. I still hadn’t seen my knee, but it was feeling great for someone fresh out of surgery, and I was happy.
T+Plus 4 Days: Unwrapping my Present
Post-op instructions indicated I was to unwrap my surgical dressings on post-op Day 3, but between energy level, timing, and the baseball game, I pushed that back to first-thing on Day 4. As eager as I was to actually see my knee for the first time, I was pretty nervous about removing the surgical dressing which was so well applied — it was comfortable, and it felt life a safe cacoon. Really they do need to be changed to avoid very dangerous infection.
The top of the dressing had slowly worked its way down my thigh, but it was still secure and covering well beyond the knee. I hadn’t even unlocked the brace’s closures until here; even with my leg propped up, releasing my leg from the security of the leg brace was a little unnerving. Free to move and maybe bend by accident, the knee felt so vulnerable.
The instructions sent home instructed me to “remove the surgical dressing and cover any incisions with band-aids.” I thought this was silly and unlikely when I first read it my first day home, but it would prove absurdly laughable when I finally unwrapped my leg a few minutes later.
The dressing was standard stuff; three layers: two elastic ACE wraps from my thigh to my toes, a thick layer of cotton wool padded dressing, absorbant pads, and finally large gauze pads over the surgical sites. And underneath all that I had… STAPLES!?!
Not complaining! I just was expecting sutures, so staples really surprised me. My Dad, who was helping me change the dressing, was equally surprised; “Wow, I haven’t seen staples used in a LONG time!” (referring to the military — after all, my orthopedist was an Air Force surgeon before going into private practice. Fun fact; he served as Surgical Team Chief for President George W. Bush and FLOTUS — I’m in good hands). Antibacterial Steri-Strips covered each of the 6 incisions, except when it came off with the bandages. The wounds looked good — they’re always a little bloody, but this looks very clean and healthy. The femoral incision was fully visible since the Steri-Strip was stuck to the gauze.
In total I had 19 staples. Eventhough I had a box of large Band-Aids, that obviously wasn’t safely enough. We had plenty of wound dressings on hand because of my mom’s foot surgery in 2010 which required lots of ongoing wound care since it took a year to heal.
I placed absorbant pads over the three surgical incisions, and the overlap covered the three arthroscopy incisions. I used roll gauze to gently hold the pads in place and provide light padding. Then everything is secured with the ACE bandage from the surgical center, although I only used one wrap to cover my calf to my thigh instead of my entire leg. This was comfortable, secure, only slightly less padded than how I was sent home, and more comfortable since my foot was finally now exposed. This is how I would change the dressing every other day until my 12-day post-op follow-up appointment to remove my staples (staples can only be left in for 10–14 days).
T+Plus 1 Week: Hurry Up and Wait
In the meantime, I had some good days and bad days. The bad days weren’t more painful, although there of course were days I was in more pain than others. The bad days were exhausting. By 4 days post-op I was beginning to notice the pain wasn’t onsetting as quickly or strongly as the Percocet began wearing off. In fact, it was getting to the point where I could delay taking it an hour or two (every 6 hours instead of every 4) before really needing to take it to calm my knee down. Overnight I still took it every 4hrs with an alarm to wake me up for it — everyone says if you get behind in managing the pain it’s nearly, if not impossible, to catch back up; not a chance I wanted to take since my biggest fear was pain.
The next morning, on Day 5, I woke up due for more Percocet, though I didn’t feel like I needed it. The post-op instructions had me on 600mg of Advil and 650mg of Aspirin since I got home the day of the surgery, so it’s not like I was ever analgesic-free. I decided to go get cozy sitting down as usual, but forgo the Percocet and see what happened. A little while after settling in, Imran dropped by again. While talking with him, complaining about how tired I was that day, my knee gave me a stabbing ice-pick pain under the kneecap on the lateral side, only lasting for a few seconds. But it was sore, and getting sorer; I told him about how I was trying to wean off the Percocet since the pain, which had been very manageable and livable with the Percocet, was becoming manageable without it. After about 10 more minutes of talking, the soreness was becoming more bothersome and interrupted our conversation; “I think you still need to take some of those.” “Screw it; I think you’re right.” He handed me my pill bottle, and with a gulp of water I took a dose. They would be the last two Percocets I took, however; that made four days of Percocet, and a single dose on Day 5. I perked right up, feeling more awake and comfortable once it kicked in. It was the next day that would suck the most.
The day after I quit Percocet sucked. It was the worst day I had, and that even counts the day of the surgery… and it wasn’t pain that sucked. I was just SO TIRED! I could not wake up to save my life — if there had been a fire I’m sure I would have perished. Once “awake,” AKA moved from my bed to propped up in my chair under some blankets, I once again could not stay awake for more than 10 minutes at a time, possibly less. Anything I did, from reaching for a glass of water, getting up to use the bathroom, and even eating were all sluggish and felt “drugged.” But I wans’t on any drugs except Aspirin and Advil. I even fell asleep halfway through eating dinner. The tiredness and drugged feeling made me extremely cranky; I snapped at everyone for any little thing.
The only other time I’ve ever felt like that was earlier in the year while starting a new migraine medication which knocked me asleep for 16hrs at a time at half dosage —I obviously didn’t stick with that for more than a few days.
I can only guess, and only found limited evidence to support my guess, but I think the tiredness the day after quitting Percocet was a kind of withdrawl / rebound / shock / divot effect from quitting Percocet mostly cold-turkey. For a minute I was tempted to try taking a single pill and see if it woke me up, but I didn’t — I wasn’t in pain enough to need it today; the Advil and Aspirin were working just as well today as the Percocet had been the first four days.
After spending half the day sitting with the TV on finding it impossible to stay awake, I finally gave up and got back in bed. I slept another solid 14 hours, and woke up the next day completely refreshed, like nothing had happened. In essence I skipped a day thanks to needing a ton of sleep after getting off “the hard stuff.” My friend Kelly texted asking to grab sushi while she was in town that evening, unaware I’d even had surgery; I told her if she grabbed Chinese she could come hear about my surgery and watch that night’s Nats game — I wasn’t going out anywhere!
T+Plus 1 Week: Wrap Up
My first week was about what I expected in activity level and inconvenience, but differed in that I was in a LOT less pain than I expected, and was most plagued by inability to concentrate. My mental capacity was only up to holding an immediate conversation or replying to text messages — that part really surprised me. I’d had every intention of writing this blog on the fly beginning that week, but I didn’t have the focus to even edit some basic vacation photos, let alone put thought into composition; I’m still struggling to concentrate and write creatively as of right now (I’m 5 weeks post-op as of this writing).
My initial advice is to have everything ready for you before you go under the knife. Get everything clean, do your laundry, stock up on all your basic supplies like toilet paper and soap and anything else you can think of that will be inconvenient, annoying, and time-consuming to replenish while you’re stuck on one foot with no energy. Eliminate all tripping hazards, and don’t get lazy about them once you are out of surgery — pick up after yourself and don’t leave anything laying about, even-though the temptation will be high while your energy is low — be smart, safe, and don’t take any risks; you want the surgery to heal right without you doing anything stupid to it.
Finally, make sure you have a good support system, as lame as I think that term sounds — you will be reliant upon others for almost everything for the three or so weeks you are stuck non-weight bearing on two crutches; be sure to have someone with you at all times who can help prepare food and carry things from room to room — I drink coffee and ice water like theyre… water, and carrying those from the kitchen is impossible without help. Cooking is just too much energy, and is outright painful when just getting up to use the bathroom causes a sensitive blood-rush to the leg. Also, stick to foods that are mild and “safe;” I love my spicy foods, but I’m smart enough to know that if one of them doesn’t sit right, needing to rush to a toilet and go through the difficult process of dropping your drawers while there’s… urgency… would suck — don’t risk it; just save the spicy foods for when your knee is feeling better, and play it safe on your stomach until then.
It seems obvious, but I’ll mention it anyway; go to surgery, and return home wearing stretchy clothing like athletic / gym shorts, a T shirt, and slip-on shoes if you have them; continue to wear these until you’re solidly into your recovery. They make everything easier to do, and access to your leg is totally unhindered.
Finally, and this isn’t an option for everyone, but I wear athletic boxer-briefs that go down my thigh; this kind of underwear is very comfortable becuase if you place your brace over the underwear, it’s one less irritating area on the skin. This tip adds a layer of complexity to bathroom visits, but for me was well worth it for comfort; it keeps the thigh strap from getting itchy, plus reduces the brace’s skin exposure so it doesn’t pick up sweat as quickly — the brace’s pads are going to start to stink no matter what, but any barrier delays and reduces the stink from setting in. Replacement pads are available on Amazon for ~$40, but since the pads only start to smell after about a month, and you’re only in the brace for about 2 months, it’s up to you if you want to get them or not. The pads can be washed, but only air dried, and frankly you gotta wear the brace, so I’m opting to just stick it out since it’s only noticeable when you take the brace off. Once I am out of the brace and into my compression brace again, the pads (which are just velcroed on) will get a good cleaning in the wash cycle.
Next post I’ll be talking about the final two weeks stuck on crutches before weaning back into weight-bearing status! This will include how I manage to shower and do other everyday tasks.
